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Democrats paid a heavy toll to keep health care reform moving forward. They were forced to accept substantial and virtually unprecedented limits on abortion coverage in order to get the Affordable Health Care for America Act through the House of Representatives. This result should awaken them to the need to rethink their approach, but it assumes they learned the key lesson: where government goes, ideology follows.

This post is not about the politics or morality of abortions. Readers of this blog are on both sides of this issue. This blog is about health care reform and what happened to HR 3962 concerning abortion highlights one of the greatest pitfalls in Democrats approach to reform. If they continue down the road they are on, increasing the amount of America’s health care system government directly controls and manages, the party is guaranteeing that similar defeats on similar public policy issues is all but a certainty. The issue today is abortion. In the future it could be access to birth control. Or making coverage available to domestic partners. The fact is, government-run health care does not and cannot exist in a vacuum. Politics and ideology inevitably come along for the ride.

The final health care reform bill may loosen the prohibition on abortion coverage contained in the House bill. But if the restrictions are diminished, it will be because Democrats led by Speaker Pelosi and Senate Majority Leader Harry Reid are in control of Congress and President Barack Obama occupies the Oval Office.

For now.

Eventually conservatives will be in power again. No party or ideology dominates America’s politics forever. And a conservative government will not hesitate to use the tools given to it by Democrats to push forward their agenda merely because those tools were created by liberals.

No one should be surprised about this political reality. In a post back in August 2007 I warned single payer advocates that a government takeover of health insurance would open the door to ideology meddling by conservatives. And in August of this year I reminded liberals that while Democrats are ascendant today, politics, like a pendulum, eventually changes direction. “In 2001 the President was George W. Bush, the Senate Majority Leader was Trent Lott and the House Speaker was Dennis Hastert (just two years earlier it had been Newt Gingrich). Their view of how a public health plan should work – what it covers and who it benefits – varies considerably from the Obama/Reid/Pelosi view. Yet the greater the role liberals give the government over health care, the more control over issues like abortion conservatives like Bush/Lott/Hastert will have when they take power again – and eventually, they will.” And I’m hardly the only observer to state this reality.

So Democrats face a critical choice. They can pursue their health care reform goals care by increasing government’s direct participation in the market or by looking to the regulations the government imposes on the market. One opens the door wide to groups of lawmakers holding health care reform hostage to unrelated public policy issues; the other narrows this opening.

For example, lawmakers want to prohibit carriers from denying consumers coverage because of their current or previous health conditions. Creating a health insurance exchange is one method of achieving this goal, but it is not the only way. And alternatives limit the opportunity for ideological meddling in Americans’ lives.

Yes, a public plan would increase competition in the market (a primary justification for a government-run plan), but so would health insurance co-operatives. And as non-government entities, co-operatives would be less susceptible to partisan interference.

By focusing on their goals and being careful of their methodology for achieving them, Democrats can have their health care reform and limit the price they’ll pay on other issues. Or they can continue down a road in which accepting limits on abortion coverage is merely the first of many heavy and painful tolls they will pay.

Thanks for sharing this opinion piece, but to be fair, while the column ran in the Christian Science Monitor, it is simply the opinion of an economics professor that Health Co-operatives will lead to nationalized health care. And while the professor makes one interesting and valid point (that if everyone joins together into large pools the advantage of being a large pool diminishes), his conclusion that this will destroy private carriers is unpersuasive. He seems to thinks that member-run health insurance co-operatives will drive their competitors out of business. But there’s more to competition than simply hammering providers down on their prices. There’s things like customer service, innovative products, sales and marketing savvy and host of other factors. And even on the issue of price, there’s little evidence non-profit co-ops will be able to drive a better bargain than for-profit plans, let alone other non-profit carriers.

Health insurance co-operatives are unlikely to harm the private carriers. Instead, they could bring needed competition to those communities where a few — or sometimes just one — health plan dominates the market. Elsewhere, they’re likely to be irrelevant.

a public option will NOT increase competition, this is once again totally wrong, a canard… the govt. will deficit spend to UNDERCUT, UNDERPRICE, and drive out the private carriers…a govt. provided plan was, is and always WILL be a Trojan Horse which will without question destroy the private primary health insurance industry, and with it all agents

There are two things the government can do that NO private insurance company can do.

Number ONE — They can pass laws. They can and as it stands now will pass laws to make premiums go up for health insurance.

Number TWO — The government does not have the same requirement of capital reserves to underwrite health insurance. They can make a call to the Federal Reserve to print more money and they are in business.

How can a “public” option be fair? It is obvious that many politicians want government run health care.